A rare case of reactive arthritis with intermittent hematuria in a young male


  • Bhargavan Pallivalappil Department of General Medicine, Baby Memorial Hospital, Kozhikode, Kerala, India
  • Anuja Jacob Baby Memorial Hospital, Kozhikode, Kerala, India
  • Sadab Raza Khan Baby Memorial Hospital, Kozhikode, Kerala, India
  • Sherin Khader Baby Memorial Hospital, Kozhikode, Kerala, India
  • Babitha Mekkayil Department of Rheumatology, Baby Memorial Hospital, Kozhikode, Kerala, India




ReA, Reiter’s syndrome, Hematuria, Chlamydia trachomatis, Posterior nutcracker syndrome


Reactive arthritis (ReA) is an inflammatory arthritis that manifests days to weeks after a gastrointestinal or genitourinary infection. It is also described as a classic triad of arthritis, urethritis, and conjunctivitis. Here we discuss the clinical presentation of ReA in a 20-year-old male who presented with typical triad of symptoms. But there was presence of hematuria which couldn't be explained by this single diagnosis. So further investigations where necessary to find the cause of his haematuria. A 20-year-old male student with history of childhood onset renal stone disease presented with complaints of dysuria for 3 days followed by bilateral conjunctival congestion along with pain around right hip joint, painful swelling around right ankle joint for 2 days. All examination were normal except for bilateral conjunctivitis and features of right ankle joint arthritis. His blood investigations showed neutrophilic leucocytosis with raised CRP levels. Chlamydia IgM Antibody was detected positive, which revealed the causative organism being Chlamydia Trachomatis. Urine routine showed 50-55 RBC’S and 2+ proteinuria. Hematuria was attributed to the CT evidence of renal stone and abnormal retroaortic coarse of his left renal vein described as posterior nutcracker syndrome.


Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Eriksson JG, Puolakka K. Increasing incidence and shifting profile of idiopathic inflammatory rheumatic diseases in adults during this millennium. Clin Rheumatol. 2019;38(2):555-62.

Spyridakis E, Gerber JS, Schriver E, Grundmeier RW, Porsch EA, St. Geme III JW et al. Clinical features and outcomes of children with culture-negative septic arthritis. J Pediatric Infect Dis Soc. 2019;8(3):228-34.

Carlin E, Marzo-Ortega H, Flew S. British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. Int J STD AIDS. 2021;32(11):986-97.

Ikeda M, Yu DT. The pathogenesis of HLA-B27 arthritis: role of HLA-B27 in bacterial defense. Am J Med Sci. 1998;316(4):257-63.

Cheeti A, Chakraborty RK, Ramphul K. Reactive arthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Gozzo C, Farina R, Foti PV, Iannace FA, Conti A, Pennisi I et al. Posterior nutcracker syndrome.: a case report. J Med Case Rep. 2021;15(1):42.

Korkes F. Nutcracker syndrome: how are we cracking the nuts and whose nuts are we cracking? Int Braz J Urol. 2017;43(4):788-90.

Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552-9.

Bănicioiu-Covei SI, Vreju AF, Rosu A, Ciurea PL. The importance of HLA-B27 in the evolution of reactive arthritis. Mayo Clin Proc. 2010;85(6):552-9.

Alexander SA, Kim E, Mandhadi R. Approaching reactive arthritis associated with poor prognostic factors: a case report and literature review. Cureus. 2021;13(2):e13555.






Case Reports